Provider Demographics
NPI:1215008040
Name:MAG MEDICAL, PC
Entity Type:Organization
Organization Name:MAG MEDICAL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:MERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-375-0392
Mailing Address - Street 1:27 BEAUMONT ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-4103
Mailing Address - Country:US
Mailing Address - Phone:718-375-0392
Mailing Address - Fax:718-375-4324
Practice Address - Street 1:2379 65TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-4045
Practice Address - Country:US
Practice Address - Phone:718-375-0392
Practice Address - Fax:718-375-4324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY196595207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW35471Medicare ID - Type Unspecified